December 13, 2021

Dear PHL friends,

This was a very challenging year as we had to cope with the evolving nature of the COVID-19 pandemic and all the political and economic ramifications of it. PHL had an ambitious agenda for this year that included the planning of two mission trips, the assembling and shipping of a container, educational support for health care providers in Nicaragua and bringing one or two patients to the US for interventions or complex procedures not available in Nicaragua. We have achieved a lot, but we have not been able to do any medical mission trips yet.

We planned a clinical trip to see patients who are potential candidates for interventions in late May 2021. The trip was canceled due to COVID-19 cases peaking in Nicaragua in early May and additional travel hurdles for some of the team members. Similarly, Dr. Brumfield and the electrophysiology team organized a trip that was scheduled for August 2021. That trip was unfortunately canceled due to several team members being exposed to a COVID-positive patient a few hours prior to departure. Despite the limitations, Ruben Centeno was able to visit the hospital in Leon to assess the status of supplies and equipment for future trips.

Organizing medical missions nowadays is more challenging than before. Most of the US’ airlines are not flying to Nicaragua and only Avianca has regular flights to the country. Typically, it will take 24 or more hours for a volunteer to get from the US to Managua. Additionally, a negative COVID-19 test is required 36 hours prior to arrival to Managua, which makes it very difficult to plan flights and testing. Fortunately, testing has now become more widely available in the US, but we must somehow predict the infection rate in Nicaragua at the planned date of the mission as well. Elevated cases, low local vaccination rates and circulation of new COVID-19 variants could tremendously stress the local health care system. We must also plan to face the possibility of changed quarantine or testing policies on our return to the US. Despite all the above, we firmly believe that a carefully planned and executed mission trip is still possible for next year. If the situation allows, we are hoping to return in early summer of next year.

We were able to assemble and ship a container which was received by the hospital administration in Leon, Nicaragua in January of this year. The container had personal protection equipment for health care providers working in the COVID-19 units in Leon. It also had collected clothes and footwear for the communities affected by the hurricanes Eta and Iota that hit the east coast of Nicaragua just a few weeks apart. Additionally, we sent one anesthesia machine, one EKG machine, several monitors/defibrillators, two treadmill units for stress testing, perfusion coolers and disposable supplies for open heart surgery and the critical care unit. A surgical headlamp was also sent to be used by Dr. Hernandez, the pediatric cardiac surgeon, working in the pediatric heart surgery program in Managua. Zion Lutheran Evangelical Church in Waterville, Ohio donated funds to buy one ECG machine for the pediatric cardiology department in Leon. To all our friends and collaborators that donated money and their valuable time, many thanks. Without your support all of this wouldn’t be possible.

We don’t anticipate sending another container anytime soon. The pandemic has also disrupted the global movement of freight while boosting demand for consumer goods. The cost of container shipping has increased by at least a factor of five, hence we are not planning on sending a container until the situation changes.

We did succeed in bringing one patient to the US for medical care. The pandemic has stressed the health care system around the world and it’s more difficult to find sponsorship from hospitals to bring patients to the US to treat complex conditions or conditions that simply cannot be treated in Nicaragua due to lack of resources. We were fortunate to find sponsorship from UNC-Nash and Abbott to bring this patient who was at constant risk of sudden cardiac death. This patent had the defibrillator implanted many years ago in Nicaragua by PHL, but the device battery expired early this year. Our dear friend and collaborator Dr. Bumgarner graciously agreed to perform the defibrillator change out at UNC Nash Heart Center. The patient did well after the procedure and is back in Nicaragua enjoying his family. The patient’s transportation was sponsored by PHL. Lodging accommodations were provided by volunteers. We are confident that more patients could benefit in the future from complex medical care in the US, as such treatments are simply not available in Nicaragua.

The pandemic forced us to develop new ways of working and teaching. PHL launched in our website a series of short lectures in Spanish directed to physicians, residents and medical students in Nicaragua. We were also able to kickstart a few live lectures with invited speakers over Zoom. This is still a work in progress and we believe that it has been a valuable endeavor that has low cost and high impact in terms of improving the quality of the health care for the people of Nicaragua. We also raise money to sponsor an observership for a talented Nicaraguan graduate physician who is in the midst of applying for residency here in the United States. I can’t express enough gratitude to all of those who contributed with money and time to achieve the educational goals of PHL.

Nicaragua held its presidential elections in November, which were widely criticized by many countries and led to sanctions of Nicaraguan government officials. Because of those sanctions, we expect that the economy, and hence the health care, will become even worse making PHL’s humanitarian work more important than ever to Nicaragua.

PHL receives no government funding. Therefore, our work depends on private donations. Medical equipment, supplies, and shipping are very expensive, and your financial contributions are needed in order for PHL to continue its mission of helping the people of Nicaragua. Please consider contributing. Checks should be made payable to PHL and mailed to the address found in the letterhead. Contributions are tax-deductible. If you are interested in volunteering for a brigade, please contact us at this email;


Carlos A. Espinoza, MD, FACP, President

Mike Yeung, MD, FACC, Vice president

Jack Rose, MD, FACC, President Emeritus

John Paar, MD, President Emeritus